| NPI | 1902844376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12161) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 12161) |
| 225100000X Physical Therapist (Licence: AK 1566) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2024-08-05 |