| NPI | 1225411267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-4070) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 42664) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2025-12-29 |