| NPI | 1285168369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10672) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 39-1799960) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2020-09-18 |