| NPI | 1114193778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: IN A 0294 P) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MT RN32307) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2010-02-23 |