| NPI | 1427531722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: 2305212105) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT1870) |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2024-10-21 |