| NPI | 1770479651 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT43235) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PTT43235) |
| Enumeration Date | 2025-06-16 |
| Last Update Date | 2025-08-14 |