| NPI | 1679939581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0133981) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 293084) |
| 225100000X Physical Therapist (Licence: ME 4587) | |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2018-03-24 |