| NPI | 1689601676 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 003501) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT009766) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2021-06-29 |