| NPI | 1134826084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHILOH JORDAN BESAW Board President 920-538-6368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 172M00000X Mechanotherapist |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2023-02-10 |
| Last Update Date | 2023-02-10 |