| NPI | 1548950249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 8671) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03663) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2024-12-20 |