| NPI | 1376517912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT01857) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 007640) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2011-10-06 |