| NPI | 1871915033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1816) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9210) |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2021-11-01 |