| NPI | 1093312928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT6935) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 13369690) |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2025-01-23 |