| NPI | 1558032094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 047432) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT7070) |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2025-07-10 |