| NPI | 1144279308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI 02580) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CO 5367) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2013-06-18 |