| NPI | 1659129153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2191) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 11353) |
| Enumeration Date | 2024-05-09 |
| Last Update Date | 2024-05-09 |