| NPI | 1407415334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14891) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 11514) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2024-08-28 |