| NPI | 1528258001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 1480) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI 00214) |
| 225100000X Physical Therapist (Licence: ME 2186) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2007-07-31 |