| NPI | 1598996654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9270) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 18757) |
| 225100000X Physical Therapist (Licence: MT 11380) | |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2023-08-02 |