| NPI | 1215592910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT5572) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 4504) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2022-09-26 |