NPI | 1982251567 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT5454) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ME PT5454) |
Enumeration Date | 2019-08-20 |
Last Update Date | 2022-10-31 |