| NPI | 1730189564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 17637) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME 2853) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2026-04-20 |