| NPI | 1881976280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: PA MSG000256) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: FL MA58933) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2011-09-13 |