| NPI | 1710728092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT033425) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT6830) |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2025-07-05 |