| NPI | 1366588022 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 5027) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 8501) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2012-10-09 |