| NPI | 1356148548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 310031) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216963) |
| Enumeration Date | 2025-02-26 |
| Last Update Date | 2026-07-10 |