| NPI | 1841832680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT5511) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9696) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2019-10-21 |