| NPI | 1134137888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT6780) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 6825) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2024-10-15 |