| NPI | 1760194302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 303251) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT7355) |
| Enumeration Date | 2022-12-14 |
| Last Update Date | 2026-07-22 |