| NPI | 1194619411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT7218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 20614) |
| Enumeration Date | 2025-06-03 |
| Last Update Date | 2025-08-12 |