| NPI | 1760557094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT13831) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 2421) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2024-09-18 |