| NPI | 1538242847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT267) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 8724) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2019-03-21 |