| NPI | 1710446257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34415) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT5363) |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2023-06-07 |