| NPI | 1750982435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 30270) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MN A2463) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 2889) | |
| Enumeration Date | 2020-11-08 |
| Last Update Date | 2020-11-08 |