| NPI | 1407341696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MN 11260) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MN 4641) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2019-09-04 |