| NPI | 1518253756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: ME PT 4013) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 11274) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2013-03-12 |