| NPI | 1992231732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11163) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: SD 1974) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2020-03-05 |