| NPI | 1659973295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: OK 183959) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: TX MT019877) |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2022-12-23 |