| NPI | 1124072566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 35656) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT2914) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2021-12-07 |