| NPI | 1013725878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 310029) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 65535) |
| 225100000X Physical Therapist (Licence: NV 6987) | |
| Enumeration Date | 2024-12-26 |
| Last Update Date | 2026-07-22 |