| NPI | 1366454605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3435) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME 3665) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2022-11-11 |