| NPI | 1194732487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT01727) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: RI PT01727) |
| 225100000X Physical Therapist (Licence: MA 18747) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2013-01-17 |