| NPI | 1962940320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MN A1957) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MN E3018291) |
| 225200000X Physical Therapy Assistant (Licence: TX 2115596) | |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2017-02-06 |