| NPI | 1568963619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO 14274) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 9560) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2018-02-23 |