| NPI | 1841461076 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 8280) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: IL 070013392) |
| Enumeration Date | 2008-03-15 |
| Last Update Date | 2017-10-23 |