| NPI | 1720497688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 2157) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9352) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2023-02-13 |