| NPI | 1073489803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: WV 2020-3788) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: NC 22243) |
| Enumeration Date | 2025-10-17 |
| Last Update Date | 2025-10-17 |