| NPI | 1740266766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 4634) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MN 4634) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2024-05-02 |