| NPI | 1619407285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2358) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 1998) |
| 225100000X Physical Therapist (Licence: MN 11624) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2019-12-26 |