| NPI | 1073061115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: ME AT272) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: ME AT272) |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2016-09-19 |