| NPI | 1902539778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MN 12222) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 64446) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2024-02-15 |