| NPI | 1982037339 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 1515) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2018-02-12 |