| NPI | 1124919949 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP046569T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX CP049797T) |
| Enumeration Date | 2025-07-10 |
| Last Update Date | 2025-10-13 |