| NPI | 1104481472 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24205) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043789) |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2024-04-16 |