| NPI | 1083572952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 14237) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 5302) |
| Enumeration Date | 2026-01-12 |
| Last Update Date | 2026-02-10 |