| NPI | 1073670071 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 029689-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.012858) |
| 225100000X Physical Therapist (Licence: MO 2001028979) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2008-05-14 |