| NPI | 1063969061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 047240-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT4697) |
| 2251S0007X Physical Therapist, Sports (Licence: ME PT4697) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: ME PT4697) | |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2021-08-17 |