| NPI | 1336127166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 1789) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MN 1789) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2021-01-06 |