| NPI | 1063026615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03434) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-7116) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2024-03-07 |