| NPI | 1386644110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT2598) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 8285) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2015-12-07 |