| NPI | 1700397692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO PTA.0013628) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2110911) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2017-10-18 |