| NPI | 1386155125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 2590) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 01638) |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2018-03-17 |