| 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 |