| NPI | 1871128058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT5558) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 007781) |
| 225100000X Physical Therapist (Licence: NY 043826) | |
| Enumeration Date | 2020-03-08 |
| Last Update Date | 2020-03-08 |