| NPI | 1760662134 |
|---|---|
| Other Name | NA NA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: TX 2064616) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: MD A3206) |
| 172M00000X Mechanotherapist (Licence: PA TE007995) | |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2007-11-13 |