| NPI | 1760870653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: NC A-694) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: NC A-694) |
| Enumeration Date | 2014-12-31 |
| Last Update Date | 2014-12-31 |