| NPI | 1700433877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21108) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03217) |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2022-04-26 |