| NPI | 1548238652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4183) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT0000007385) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2019-11-20 |