| NPI | 1265512867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MA 15148) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: RI PT1539) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2009-06-01 |