| NPI | 1477148997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12893) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 162531) |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2023-09-08 |