| NPI | 1912571100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12233) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| 225100000X Physical Therapist | |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2021-06-10 |