| NPI | 1295008761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 8649) |
| Additional Taxonomies | 224Y00000X Clinical Exercise Physiologist |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2016-03-25 |