| NPI | 1912578790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0016517) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT5406) |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2024-08-07 |