| NPI | 1417293432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 20328) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT02550) |
| Enumeration Date | 2012-12-19 |
| Last Update Date | 2023-04-04 |