| NPI | 1851426928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MA 12124) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: RI 01338) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2009-09-28 |