| NPI | 1982200473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 15951) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 21849) |
| 225100000X Physical Therapist (Licence: MD 28172) | |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2022-10-03 |