| NPI | 1134286172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME 00234) |
| Additional Taxonomies | 171W00000X Contractor (Licence: ME 00234) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2008-01-30 |