| NPI | 1376129775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12025) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 4791) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2026-05-29 |