| NPI | 1629505359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12361) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 1990) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2021-10-25 |