| NPI | 1710023478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 012791) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT1841) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-07-08 |