| NPI | 1639346505 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2164) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-04049) |
| Enumeration Date | 2008-05-10 |
| Last Update Date | 2010-04-15 |