| NPI | 1689960502 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 36565) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1220967) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2019-10-21 |