| NPI | 1770879124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT02905) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 0400090284) |
| 225100000X Physical Therapist (Licence: VA 2305206947) | |
| 225100000X Physical Therapist (Licence: NH 3680) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2016-06-13 |