NPI | 1578818514 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11794) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0011762) |
Enumeration Date | 2012-07-16 |
Last Update Date | 2024-11-05 |