| NPI | 1801130794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: VA 0019009629) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: DC MT1634) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2013-07-10 |