| NPI | 1972180271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11907) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 15398-24) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2023-06-12 |