| NPI | 1336153824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 13119) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT01593) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2025-01-03 |