| NPI | 1205326899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 302432) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT5077) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2022-08-10 |