| NPI | 1861379000 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30729) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 054658) |
| Enumeration Date | 2025-08-19 |
| Last Update Date | 2026-08-02 |