| NPI | 1669619151 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WI 861019) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IL 160002250) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2009-01-21 |