| NPI | 1619865243 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT034725) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: IA 131374) |
| Enumeration Date | 2025-06-24 |
| Last Update Date | 2026-04-29 |