| NPI | 1003438094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO PTA.0014491) |
| Additional Taxonomies | 376G00000X Nursing Home Administrator (Licence: CO NHA.0003063) |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2025-10-06 |