| NPI | 1659102507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 052420) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT6805) |
| Enumeration Date | 2024-08-12 |
| Last Update Date | 2024-09-10 |