| NPI | 1194973891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 8449) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 11079-24) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2025-03-17 |