| NPI | 1053760157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 011339) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT4733) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2021-06-22 |