| NPI | 1780999433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI pt02321) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: RI PT02321) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2022-04-04 |