| NPI | 1528789617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13154) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MN 13154) | |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2024-11-21 |