| NPI | 1154879112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT02947) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 22393) |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2016-09-19 |