| NPI | 1528505658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9798) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: MN 9798) |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2020-09-30 |