| NPI | 1912493768 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT305645) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 24050) |
| 225100000X Physical Therapist (Licence: AL PTH8932) | |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2024-12-13 |