| NPI | 1427101286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9478) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT32436) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-10-14 |