| NPI | 1770076069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03152) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 11916) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2020-03-04 |