| NPI | 1396135505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24054) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03051) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2020-03-03 |