| NPI | 1013316868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03504) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60955427) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MA 21768) | |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2022-07-20 |