| NPI | 1306733746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13449) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16704) |
| Enumeration Date | 2025-06-19 |
| Last Update Date | 2025-06-19 |