| NPI | 1902598162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 308260) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501302487) |
| 225100000X Physical Therapist (Licence: AZ 033956) | |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2025-08-28 |