| NPI | 1477199149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT7042) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 11305354-2401) |
| Enumeration Date | 2019-11-18 |
| Last Update Date | 2026-06-16 |