| NPI | 1992456420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12507) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-32119) |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2022-03-14 |