| NPI | 1538924295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT2554) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL9924) |
| Enumeration Date | 2024-02-20 |
| Last Update Date | 2024-02-20 |