| NPI | 1598195521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 20675) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03466) |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2022-01-12 |