| NPI | 1750757522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 14251-24) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MN 10078) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2024-04-22 |