| NPI | 1083770572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT02075) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PT11181) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2007-07-08 |