| NPI | 1588454649 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL27302) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 014288) |
| Enumeration Date | 2025-05-10 |
| Last Update Date | 2025-05-10 |