| NPI | 1598011959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: PA TE009282) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: MD A2790) |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2012-08-02 |