| NPI | 1609976075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4337) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040-0003692) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2025-10-08 |