| NPI | 1972624567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 18419) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI 02275) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2013-03-18 |