| NPI | 1629203484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3431) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT3723) |
| Enumeration Date | 2009-05-22 |
| Last Update Date | 2019-05-03 |