| NPI | 1922567403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT6905) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 225100000X Physical Therapist | |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2024-09-10 |