| NPI | 1760846158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT6213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 12591) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2025-07-08 |