| NPI | 1891906137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO CO-0013082) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA CAPTA-4698) |
| 225700000X Massage Therapist (Licence: CO CO-4698) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2025-01-07 |