| NPI | 1700241825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10231) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT31019) |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2016-07-07 |