| NPI | 1154660017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8046) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT02555) |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2021-07-13 |