| NPI | 1235698788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03354) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 14521-24) |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2021-02-10 |