| NPI | 1922165042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: AL 6053) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA00017755) |
| 172M00000X Mechanotherapist (Licence: WA MA00017755) | |
| 225700000X Massage Therapist (Licence: WA MA00017755) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2022-10-24 |