| NPI | 1841650660 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT871922) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25901) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2024-07-30 |