| NPI | 1518684067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 32719) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 12879) |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2022-12-12 |