| NPI | 1598790214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT3384) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT011406L) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-06-21 |