| NPI | 1164760641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: OR 20616) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: WA MA60254453) |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2015-07-13 |