| NPI | 1629632567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL26153) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03195) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2025-04-29 |