| NPI | 1194029702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 13019) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: RI PT01941) |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2010-12-23 |