NPI | 1235683863 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 16477) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT5996) |
Enumeration Date | 2016-08-11 |
Last Update Date | 2021-11-02 |