| NPI | 1083365662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT6705) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-32131) |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2024-02-21 |