| NPI | 1306532478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 300445) |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2025-07-25 |