| NPI | 1598178766 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60477755) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0012635) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2014-06-25 |