| NPI | 1801400585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2377) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 12032) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2022-05-20 |