| NPI | 1336539394 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9391) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011807) |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2025-02-19 |