| NPI | 1790735819 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ QA00840900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 25352) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2007-07-08 |