| NPI | 1902223530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO 0013302) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CO 13302) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2020-03-18 |