| NPI | 1811753031 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23275) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT6674) |
| 225100000X Physical Therapist (Licence: NY 050990) | |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2025-01-27 |