| NPI | 1316376213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MN A358) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX 5934) |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2013-11-01 |