| NPI | 1336598705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO PTA.0013719) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 9182) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2016-06-07 |