| NPI | 1164847059 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 037532) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-3406) |
| 225100000X Physical Therapist (Licence: GA 012270) | |
| Enumeration Date | 2014-02-28 |
| Last Update Date | 2016-02-18 |