| NPI | 1649672411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10905) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0012918) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2019-07-30 |