| NPI | 1740595412 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1251021) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01357700) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2020-03-03 |