| NPI | 1548784655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23340) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT4886) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2018-12-18 |