| NPI | 1609248707 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ LPT-30744) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4499) |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2025-02-13 |