| NPI | 1366047482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 302345) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046646) |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2025-06-21 |