| NPI | 1992251839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10540) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36727) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2024-04-25 |