| NPI | 1003122615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO PTA.0014221) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WY PTA0672) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2018-12-19 |