| NPI | 1346281565 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 005596) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 005596) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2016-01-28 |