| NPI | 1013449677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03178) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL26851) |
| 225100000X Physical Therapist (Licence: NY 040482-1) | |
| 225100000X Physical Therapist (Licence: VA 2305216580) | |
| 225100000X Physical Therapist (Licence: CT PTN0033119) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2024-08-30 |