| NPI | 1366313306 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine (Licence: CA 95829) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: CA 95829) |
| 225700000X Massage Therapist (Licence: CA 95829) | |
| Enumeration Date | 2025-09-15 |
| Last Update Date | 2025-09-15 |