| NPI | 1053668954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO PTA.0012906) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WY PTA-0763) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2015-04-03 |