| NPI | 1740728435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03472) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P16901) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2022-08-02 |