| NPI | 1174946081 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 013562) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 003128) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2014-01-28 |