| NPI | 1467930669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4277) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23410) |
| 225100000X Physical Therapist (Licence: ME PT5017) | |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2021-09-10 |