| NPI | 1699205856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 31101) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9314) |
| 225100000X Physical Therapist (Licence: ND 2086) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2021-12-01 |