| NPI | 1699838748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03280) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 008220-1) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2024-03-18 |