| NPI | 1699446302 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11793400-2401) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: UT 11793400-2401) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: UT 11793400-2401) | |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2021-09-22 |