| NPI | 1821594011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 2782) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: MN 2782) |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2018-04-05 |