| NPI | 1356882765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10716) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-17 |
| Last Update Date | 2023-01-26 |