| NPI | 1285040766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT5110) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20110) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2018-07-17 |