| NPI | 1972257251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT03996) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC PT.9967) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2025-09-18 |