| NPI | 1609033851 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 007541) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: CT 007541) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2008-05-16 |