| NPI | 1740969856 |
|---|---|
| Former Name | RILEY KIMMINAU |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-07283) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA CP031999T) |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2024-06-24 |