| NPI | 1538324066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4597) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 005605) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2016-05-05 |