| NPI | 1851787790 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35821) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH8972) |
| 225100000X Physical Therapist (Licence: CA 42329) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2024-11-18 |