| NPI | 1780530220 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305217653) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 300601) |
| Enumeration Date | 2026-03-06 |
| Last Update Date | 2026-05-06 |