NPI | 1013270784 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13836) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9081) |
Enumeration Date | 2012-06-19 |
Last Update Date | 2024-11-01 |