| NPI | 1952638470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21216) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT1017) |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2023-04-21 |