| NPI | 1619352275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 10520) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT4419) |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2015-07-24 |