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 |