| NPI | 1073918959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03743) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209127) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2023-11-15 |