| NPI | 1487324042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT40449) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 12400) |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2023-10-19 |