| NPI | 1568297828 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT138910) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 306956) |
| Enumeration Date | 2024-09-05 |
| Last Update Date | 2024-10-28 |