| NPI | 1598484933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 25390) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 12769) |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2022-08-26 |