| NPI | 1841441557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4450) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT1843) |
| 225100000X Physical Therapist (Licence: MA 25468) | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2024-03-12 |