| NPI | 1316558547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13866) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1334061) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2025-06-02 |