| NPI | 1841488228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: OR 4667) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: CO 000639) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2007-10-10 |