| NPI | 1780350371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT6029) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 5078) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2022-11-03 |