| NPI | 1861622011 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 008560) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 008560) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2025-02-12 |