| NPI | 1346474079 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2132) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 03826) |
| Enumeration Date | 2009-05-09 |
| Last Update Date | 2021-07-25 |