| NPI | 1669643706 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 03268) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SD 2018) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2019-07-09 |