| NPI | 1568138576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 14353) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-7512) |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2026-05-21 |