| NPI | 1811187776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13443) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204425) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2026-09-15 |