| NPI | 1114221140 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MN A1314) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2080372) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2011-01-05 |