| NPI | 1932888443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03992) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 13160) |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2025-06-03 |