| NPI | 1306444047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4728) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT5745) |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2026-06-09 |