| NPI | 1629879820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 238796) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 13136) |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-08-27 |