| NPI | 1356073746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4422) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT5146) |
| Enumeration Date | 2022-06-26 |
| Last Update Date | 2024-09-15 |