| NPI | 1447920699 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 2305214662) |
| Enumeration Date | 2021-09-19 |
| Last Update Date | 2024-05-21 |