| NPI | 1225669906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT02232) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13707) |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2020-01-30 |