| NPI | 1013564921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03769) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044743) |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2023-11-29 |