| NPI | 1497182760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9298) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| 2251S0007X Physical Therapist, Sports | |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2026-05-29 |