| NPI | 1952166274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 27412) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI 04116) |
| Enumeration Date | 2024-02-15 |
| Last Update Date | 2026-06-08 |