| NPI | 1023086154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 9616) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 022540) |
| 225100000X Physical Therapist (Licence: ME PT3758) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2017-01-16 |