NPI | 1659346229 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 2039) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1789) |
Enumeration Date | 2006-02-17 |
Last Update Date | 2015-03-18 |