| NPI | 1548713357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10615) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3626) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2022-06-30 |