| NPI | 1144234360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT02456) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 16967) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-05-27 |