| NPI | 1457045379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03709) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT00780-G) |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2023-08-29 |