| NPI | 1770986630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 0823) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 4554) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2022-07-21 |