| NPI | 1194910695 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501012956) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 008046) |
| 225100000X Physical Therapist (Licence: IN 05009140A) | |
| 225100000X Physical Therapist (Licence: PA PT018527) | |
| Enumeration Date | 2007-09-08 |
| Last Update Date | 2007-09-08 |