| NPI | 1184023160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MN 11385) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: VA 2305208866) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2022-03-29 |