| NPI | 1376379727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30527) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225100000X Physical Therapist | |
| 225100000X Physical Therapist (Licence: CA 309947) | |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2026-05-13 |