| NPI | 1184230823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35949) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT5655) |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2020-09-18 |