| NPI | 1033684105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 224L00000X Pedorthist |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2025-09-05 |