| NPI | 1972926624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4284) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20681) |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2020-04-06 |