| NPI | 1427854322 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216935) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT033122) |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2026-06-17 |