| NPI | 1720708274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT6648) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 5051) |
| 225100000X Physical Therapist (Licence: MD 29183) | |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2024-03-27 |