| NPI | 1407859515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI pt01649) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 16252) |
| 225100000X Physical Therapist (Licence: CT 008064) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2020-06-03 |