| NPI | 1609555192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13270) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 5075) |
| Enumeration Date | 2023-07-13 |
| Last Update Date | 2023-08-11 |