| NPI | 1306635677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine (Licence: CA 95463) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 95463) |
| Enumeration Date | 2025-05-03 |
| Last Update Date | 2025-05-03 |