| NPI | 1134621071 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9792) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 013582) |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2024-12-17 |