| NPI | 1295258382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2156) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MN 12341) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2025-03-14 |