| NPI | 1407522659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03830) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28612) |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2024-06-10 |