| NPI | 1922619832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12488) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 298732) |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2021-10-15 |