| NPI | 1174402622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24447) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 2858) |
| 225100000X Physical Therapist (Licence: MN 13975) | |
| Enumeration Date | 2025-08-28 |
| Last Update Date | 2025-09-23 |