| NPI | 1194525667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 51109) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 29803) |
| 225200000X Physical Therapy Assistant | |
| Enumeration Date | 2025-03-14 |
| Last Update Date | 2026-06-27 |