| NPI | 1578043063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2185) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 11351) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2022-03-04 |