| NPI | 1922065317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT02476) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008306) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2025-12-09 |