| NPI | 1184971251 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT30530) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207562) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2018-03-22 |