| NPI | 1932470168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: CO 11282) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO 11282) |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2012-08-09 |