NPI | 1912389305 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9750) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MN 9750) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 9750) | |
Enumeration Date | 2015-06-23 |
Last Update Date | 2020-08-11 |