| NPI | 1033449889 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1104528) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2009038288) |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2013-09-17 |