| NPI | 1104870773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI 02006) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 007027) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2011-07-21 |