| NPI | 1083801401 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05002026A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 001184) |
| Enumeration Date | 2007-09-30 |
| Last Update Date | 2007-09-30 |