| NPI | 1740952100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03630) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 047700) |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2023-04-13 |