| NPI | 1275173981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 300093) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03225) |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2023-05-16 |