| NPI | 1922658368 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 046065) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2020-09-09 |