| NPI | 1265171086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42274) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 4974) |
| 225100000X Physical Therapist (Licence: MN 12791) | |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2026-03-04 |