| NPI | 1811128614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9552) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8604) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2020-11-20 |