| NPI | 1104475623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO PTA0012129) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CO PTA.0012129) |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2019-09-06 |