| NPI | 1023490349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM ROBERT ETHERIDGE Prosthetist 405-323-6936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: OK C21410) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2015-11-20 |