| NPI | 1336187186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT00451) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 4416) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2011-09-21 |