| NPI | 1760517452 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT012650L) |
| Additional Taxonomies | 171W00000X Contractor (Licence: PA PT-012650-L) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2008-01-30 |