| NPI | 1013334416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4089) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA PT4089) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2014-03-24 |