| NPI | 1386224947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12640) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 15437) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2022-08-08 |