| NPI | 1780700864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT02597) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070014120) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2013-10-03 |