| NPI | 1518644426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13198) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16205-24) |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2023-08-02 |