| NPI | 1013412295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 049555) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03077) |
| 225100000X Physical Therapist (Licence: MA 23490) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2024-02-14 |