| NPI | 1750173340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24791) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 13813) |
| Enumeration Date | 2025-05-20 |
| Last Update Date | 2026-06-26 |