| NPI | 1386691525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 15759) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT01684) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2019-03-13 |