| NPI | 1114734688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 308075) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 033906) |
| Enumeration Date | 2024-12-17 |
| Last Update Date | 2025-05-16 |