| NPI | 1770211351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305217266) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 26353) |
| 225100000X Physical Therapist (Licence: RI PT03685) | |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2025-09-02 |