| NPI | 1952977175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT7186) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 25476) |
| Enumeration Date | 2021-05-28 |
| Last Update Date | 2025-10-15 |