| NPI | 1730607326 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041799-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02028800) |
| Enumeration Date | 2017-09-02 |
| Last Update Date | 2022-10-19 |