| NPI | 1215190566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT01532) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PT16301) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2008-07-08 |