| NPI | 1225174683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 2787) |
| Additional Taxonomies | 2251E1200X Physical Therapist, Ergonomics |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-03-19 |