| NPI | 1164074779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT2848) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics |
| Enumeration Date | 2019-07-13 |
| Last Update Date | 2019-12-14 |