| NPI | 1245279306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7743) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MN 7743) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2021-08-11 |