| NPI | 1417324815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 292869) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT02839) |
| 225100000X Physical Therapist (Licence: MA 21880) | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2022-02-11 |