| NPI | 1922857358 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP039881T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P23798) |
| 225100000X Physical Therapist (Licence: AZ LPT-31011) | |
| Enumeration Date | 2024-05-17 |
| Last Update Date | 2025-09-19 |