| NPI | 1437484649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 8332) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1531) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2021-08-24 |