| NPI | 1588054175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4040) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI pt02764) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2024-04-04 |