| NPI | 1578889879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18745) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT3638) |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2025-10-10 |