| NPI | 1033562368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: OR 22314) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: WA 60632491) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2016-07-21 |