| NPI | 1073094488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: 24153) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT5249) |
| 225100000X Physical Therapist (Licence: NC 18186) | |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2021-04-08 |