| NPI | 1881003044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 11817) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT4265) |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2018-05-24 |