| NPI | 1770254146 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AR 4703) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 4703) |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2022-01-20 |