| NPI | 1417369554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT02688) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI 02688) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2022-10-19 |