| NPI | 1538916077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL27626) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03672) |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2025-10-16 |