| NPI | 1841329257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3709) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT02392) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2013-06-04 |