| NPI | 1821573320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015634) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: ME PT5138) | |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2021-10-06 |