| NPI | 1679878995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03377) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032878-1) |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2026-01-12 |