| NPI | 1831432293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 20263) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT02514) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2023-07-24 |