| NPI | 1770941643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03363) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041485-1) |
| 225100000X Physical Therapist (Licence: CT 10808) | |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2022-01-20 |