| NPI | 1184073157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MN 10277) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4831) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2020-02-06 |