| NPI | 1295346567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03346) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 25094) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2020-12-01 |