| NPI | 1376368431 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02308200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT032830) |
| Enumeration Date | 2024-11-22 |
| Last Update Date | 2024-12-04 |