| NPI | 1952678047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24562) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT02446) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2023-03-28 |