| NPI | 1699332585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11540) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 4744) |
| Enumeration Date | 2019-05-25 |
| Last Update Date | 2021-07-19 |