| NPI | 1467558825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: RI PT02295) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 16094) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2011-10-03 |