| NPI | 1841670494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10964) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1982) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2020-04-09 |