| NPI | 1104169929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 049876) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI Pt02564) |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2022-11-28 |