| NPI | 1508731902 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT6889) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 5576) |
| 225100000X Physical Therapist (Licence: MA 26684) | |
| Enumeration Date | 2025-10-07 |
| Last Update Date | 2025-10-07 |