| NPI | 1720693542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2373) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 12053) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2022-10-19 |