| NPI | 1770557902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT-01733) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 19965) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2013-04-24 |