| NPI | 1104219054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT02966) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0013158) |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2021-07-23 |