| NPI | 1831508662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT02703) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21164) |
| 225100000X Physical Therapist (Licence: VA 2305208771) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2014-08-06 |