| NPI | 1881177210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT5233) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014235) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2019-10-31 |