| NPI | 1154578482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO PTA.0012625) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WY PTA-0218) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2019-05-10 |