| NPI | 1174903207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: OR 1001988) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: AZ 1405674) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2015-06-03 |