| NPI | 1578386991 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL28092) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0020375) |
| Enumeration Date | 2024-11-04 |
| Last Update Date | 2025-02-15 |