| NPI | 1609251370 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034735) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: NY 034735) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2022-03-02 |