| NPI | 1962926618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4649) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025247) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2017-08-02 |