| NPI | 1497729917 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ QA02629) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT-000695-E) |
| 225100000X Physical Therapist (Licence: MA 3455) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2007-07-08 |