| NPI | 1447884218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 11721) |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2024-08-06 |