| NPI | 1891079380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WI 1621-19) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MN A1300) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2011-10-04 |