| NPI | 1336143197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 8100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT00460) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2007-07-09 |