| NPI | 1124019567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 5591) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 2482) |
| 225100000X Physical Therapist (Licence: RI PT02133) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2016-04-06 |