| NPI | 1891102943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11643) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-30121) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2019-09-18 |