| NPI | 1497686968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03751) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 14329) |
| Enumeration Date | 2026-05-26 |
| Last Update Date | 2026-05-26 |