| NPI | 1700100476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03254) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23203) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2021-05-11 |