| NPI | 1730621095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10843) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 103389) |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2022-07-21 |