| NPI | 1396499596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03746) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214854) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2025-01-17 |