| NPI | 1023785136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 25637) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03415) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2022-03-17 |