| NPI | 1598585853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 307705) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1400094) |
| Enumeration Date | 2024-10-11 |
| Last Update Date | 2025-03-19 |