| NPI | 1952621534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MN 9203) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 11473-024) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2015-07-01 |