NPI | 1386296028 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11578) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 14758) |
Enumeration Date | 2019-07-12 |
Last Update Date | 2023-05-24 |