| NPI | 1699718403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1289) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 6271) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2026-04-29 |