| NPI | 1497103949 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 9802890-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT - 4660) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2016-05-25 |