| NPI | 1962598185 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05008020A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070007218) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |