| NPI | 1366892101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WI 1938) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MN A901) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2016-06-13 |