| NPI | 1447596507 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11993-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 41747) |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2024-10-11 |