| NPI | 1558846469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11327) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT33782) |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2020-10-15 |