| NPI | 1285071258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO 0013148) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CO PTA0013148) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2025-01-10 |