| NPI | 1255603056 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216879) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36832) |
| 225100000X Physical Therapist (Licence: TX 1146448) | |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2025-01-20 |