| NPI | 1548513096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT3939) |
| Additional Taxonomies | 273Y00000X Rehabilitation Unit (Licence: ME PT3939) |
| 225100000X Physical Therapist (Licence: WI 38694) | |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2025-01-31 |