| NPI | 1396222832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10307) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MN 10307) |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2021-11-01 |