| NPI | 1598448706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03699) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL89154) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2026-05-18 |