| NPI | 1437567682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9767) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1797) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2021-07-13 |