| NPI | 1124002431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 0401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT446) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2007-07-08 |