| NPI | 1447367594 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT CT007632) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 018229) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2008-09-17 |