| NPI | 1760049571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO PTA0014560) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AL PTA8336) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2019-05-28 |