| NPI | 1871731596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 16801) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT02059) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2009-02-03 |