| NPI | 1801322805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03380) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01708200) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2021-09-09 |