| NPI | 1811310485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4152) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1239309) |
| Enumeration Date | 2014-02-01 |
| Last Update Date | 2018-05-22 |