| NPI | 1376199265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13313) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 018243) |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2026-04-28 |