| NPI | 1891797478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI 03603) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 014677) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2023-01-18 |