| NPI | 1225055122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT01685) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 16305) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2021-10-28 |