| NPI | 1952011280 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 120752) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 097587) |
| Enumeration Date | 2022-11-28 |
| Last Update Date | 2023-08-02 |