| NPI | 1487087029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03151) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 009860) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2018-12-05 |