| NPI | 1285793422 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 10305) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI 1288) |
| 225100000X Physical Therapist (Licence: NH 3087) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2007-07-08 |