| NPI | 1821329756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13070) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032275) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2024-01-04 |