| NPI | 1306521166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41437) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 13016) |
| 225100000X Physical Therapist (Licence: OR 65009) | |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2024-03-06 |