| NPI | 1487144762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12765) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT019954) |
| Enumeration Date | 2018-05-13 |
| Last Update Date | 2023-08-10 |