| NPI | 1427461748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MN 9882) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14894) |
| 225100000X Physical Therapist (Licence: MT 5941) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2015-03-05 |