| NPI | 1770596827 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT CT0007440) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 061490) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2020-12-15 |