| NPI | 1831303486 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT 2645) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8068) |
| 225100000X Physical Therapist (Licence: CA PT 28323) | |
| 225100000X Physical Therapist (Licence: WY 1029) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2007-07-12 |