| NPI | 1427424886 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT5140) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25606) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2021-09-20 |