| NPI | 1093474876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4944) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03455) |
| Enumeration Date | 2021-12-09 |
| Last Update Date | 2022-02-28 |