| NPI | 1720482813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1576) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8869) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2022-07-21 |