| NPI | 1134520927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4287) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1250099) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2018-03-17 |