| NPI | 1164843058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT00127) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: RI PT00127) |
| 2251S0007X Physical Therapist Sports (Licence: PT00127) | |
| Enumeration Date | 2013-12-19 |
| Last Update Date | 2013-12-19 |