| NPI | 1508542572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13030) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 2794) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2025-11-17 |