| NPI | 1982085171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO PTA.0013566) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA24923) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2015-06-12 |