| NPI | 1871290916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13739) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT6419) |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2024-12-23 |