| NPI | 1215499355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MN A203) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SD 0466) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2019-04-05 |