| NPI | 1417132507 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5656) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10676) |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2022-03-17 |