| NPI | 1093214157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24235) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03134) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2026-02-19 |