| NPI | 1417105503 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2096) |
| Additional Taxonomies | 174400000X Specialist (Licence: IA 03737) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2017-09-11 |