| NPI | 1013272384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO 12813) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-02337) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2012-07-11 |