| NPI | 1831866706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12395) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MN 995660) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2021-08-26 |