| NPI | 1700039542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: WA MA60195852) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: OR 15618) |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2011-10-04 |