| NPI | 1699150714 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: IA 076469) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 076469) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2018-03-17 |