| NPI | 1407143134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT26565) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT4197) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2015-06-09 |