| NPI | 1780255331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03614) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 64115) |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2023-02-28 |