| NPI | 1376854695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 8547) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 6708) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2021-10-06 |