| NPI | 1932875416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL26725) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT6028) |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2023-05-08 |