| NPI | 1790166874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16085-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9922) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2025-05-21 |