| NPI | 1013375732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT5377) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4778) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2019-06-01 |