| NPI | 1407805179 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 7848) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: CT 7848) |
| 2251N0400X Physical Therapist, Neurology (Licence: CT 7848) | |
| 2251S0007X Physical Therapist, Sports (Licence: CT 7848) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CT 7848) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2010-12-07 |