| NPI | 1699475681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03952) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL26777) |
| 225100000X Physical Therapist (Licence: NC CP049181T) | |
| 225100000X Physical Therapist (Licence: WA PT61569766) | |
| 225100000X Physical Therapist (Licence: TX 1372542) | |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2025-10-21 |