| NPI | 1295015642 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1676) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8840) |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2021-12-10 |