| NPI | 1134487606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: DC MT0559) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: MD M04520) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2012-05-02 |