| NPI | 1497084156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 18840) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT02349) |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2010-12-09 |