| NPI | 1538003694 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211428) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ CP044084T) |
| Enumeration Date | 2026-04-17 |
| Last Update Date | 2026-05-06 |