| NPI | 1043103021 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY CP044652T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT021816) |
| Enumeration Date | 2025-05-30 |
| Last Update Date | 2025-06-09 |