| NPI | 1881051829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MN 10257) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1794) |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2022-07-21 |