| NPI | 1427720846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019064) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT6052) |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2023-06-13 |