| NPI | 1598026726 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3498) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 189604) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2022-04-12 |