| NPI | 1093262396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: CT 008049) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: NY 027658) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2016-09-02 |