| NPI | 1558729830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4302) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013794) |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2019-06-14 |