| NPI | 1255649976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 1829) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT2377) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2014-11-26 |