| NPI | 1063524742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 008663) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT01723) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-09-10 |