| NPI | 1275725368 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: WA MA 60036696) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: OR 13857) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2012-07-24 |