| NPI | 1447620190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9235) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 9235) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2024-09-19 |