| NPI | 1770059909 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027329) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT5232) |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2018-10-19 |