| NPI | 1922675677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MN A2555) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2024-09-14 |