| NPI | 1053870188 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT5442) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 42792) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2022-05-31 |