| NPI | 1083265490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03229) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24396) |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2021-09-30 |