| NPI | 1902757800 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008171) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 026311) |
| Enumeration Date | 2026-02-05 |
| Last Update Date | 2026-02-05 |