| NPI | 1942672100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT5103) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21332) |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2023-09-07 |