| NPI | 1720714603 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 046584) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 12981) |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2023-08-15 |