| NPI | 1568504421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4091) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 22779) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2025-05-30 |