| NPI | 1841859154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MN A2240) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MN A2215) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2021-07-28 |