| NPI | 1942787510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2017026662) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23614) |
| 225100000X Physical Therapist (Licence: ME PT5150) | |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2018-07-25 |