| NPI | 1134900228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL27081) |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2025-07-03 |