| NPI | 1417834763 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 055014) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY P137532) |
| Enumeration Date | 2025-08-19 |
| Last Update Date | 2025-08-19 |