| NPI | 1285086876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 25149) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03366) |
| 225100000X Physical Therapist (Licence: CA 40564) | |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2021-07-12 |