| NPI | 1952970899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12204) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 2508) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2022-12-09 |