| NPI | 1295168391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR PT61383) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT02611) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2024-03-25 |