| NPI | 1265603401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ME PT4710) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT008604L) |
| Enumeration Date | 2008-03-16 |
| Last Update Date | 2020-10-26 |