| NPI | 1730337551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 2003) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT01457) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2008-09-04 |