| NPI | 1154389674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 19342) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT02339) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2015-01-13 |