| NPI | 1437939451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13354) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 13625746-2401) |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2023-11-16 |