| NPI | 1811955115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT022319) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT2423) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2025-03-31 |