| NPI | 1376919548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10906) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 2132) |
| 225100000X Physical Therapist (Licence: ID PT-4222) | |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2025-06-08 |