| NPI | 1639362130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 8151) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004105) |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2020-10-06 |