| NPI | 1558890137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12266) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305210889) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2021-07-01 |