| NPI | 1548966708 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 049051) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 049051) |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2023-01-31 |