| NPI | 1346432309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4639) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2154) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2023-07-26 |