| NPI | 1003395070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03765) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23720) |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2023-12-04 |