| NPI | 1588181028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12143) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 13300PT) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2021-02-12 |