| NPI | 1275581795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MN 54681) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MN 2922) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 54681) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2024-08-16 |