| NPI | 1336000363 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44072) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501304001) |
| Enumeration Date | 2025-11-19 |
| Last Update Date | 2025-12-12 |