| NPI | 1477500098 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 10505) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT28556) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2021-12-07 |