| NPI | 1750031126 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02079300) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 012585) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2022-03-28 |