| NPI | 1295172609 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 20769) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 009738) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2020-01-30 |