| NPI | 1356709323 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IA 072729) |
| 225200000X Physical Therapy Assistant (Licence: NE 1143) | |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2019-01-29 |