| NPI | 1144311176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7849) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1924) |
| 2251S0007X Physical Therapist, Sports (Licence: IL 070.018314) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.003082) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2016-05-27 |