| NPI | 1811336472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO PTA.0012302) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WY 0420) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2013-06-17 |