| NPI | 1104372341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03716) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 22517) |
| 225100000X Physical Therapist (Licence: NH 4483) | |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2026-03-27 |