| NPI | 1689439812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL27378) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03906) |
| Enumeration Date | 2024-02-16 |
| Last Update Date | 2025-02-10 |