| NPI | 1134552987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9726) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 10492) |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2021-08-03 |