| NPI | 1437718558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11474) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9722) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2019-09-03 |