| NPI | 1053044396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 14223) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2023017072) |
| 225100000X Physical Therapist (Licence: AL PTH10845) | |
| 225100000X Physical Therapist (Licence: IN 05014625A) | |
| 225100000X Physical Therapist (Licence: TX 1371930) | |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2026-02-11 |