| NPI | 1093403248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13012) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1293900) |
| 2251S0007X Physical Therapist, Sports (Licence: TX 1293900) | |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2023-05-18 |