| NPI | 1083310346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13881) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16985) |
| 225100000X Physical Therapist (Licence: CA 304008) | |
| 225100000X Physical Therapist (Licence: CO 0020043) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-02-07 |
| Last Update Date | 2025-06-30 |