| NPI | 1437289659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 8555) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 37056) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 020702691) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2023-03-27 |