| NPI | 1255392338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: RI PT00742) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MA 7004) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2007-07-08 |