| NPI | 1932934627 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 308355) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1371008) |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2025-08-18 |