| NPI | 1750631834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11017) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT39963) |
| 225100000X Physical Therapist (Licence: WA PT60436636) | |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2021-10-05 |