| NPI | 1356577621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: WA MA60041531) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NA60043977) |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2009-06-01 |