| NPI | 1891137956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4442) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT3854) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2022-04-28 |