| NPI | 1073114062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03795) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 12866) |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2024-05-13 |