| NPI | 1497324594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 26196) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ME AT766) |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2022-09-11 |