| NPI | 1548423528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 18142) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 008248) |
| 225100000X Physical Therapist (Licence: RI PT03187) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2025-09-19 |