| NPI | 1831550169 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8574) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025012) |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2025-01-16 |