| NPI | 1053468223 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: ND 1121) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: MN 6775) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2007-07-08 |