| NPI | 1609471259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL88857) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03350) |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2025-10-03 |