| NPI | 1578109641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO PTA.0012277) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO AT.0000502) | |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2023-02-07 |