| NPI | 1518731298 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00898300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT013766L) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2023-11-13 |