| NPI | 1063466308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: RI PTA00318) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: RI MT00964) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2007-07-08 |