| NPI | 1093878522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225000000X Orthotic Fitter |
| Additional Taxonomies | 222Z00000X Orthotist |
| 224P00000X Prosthetist | |
| 225500000X Specialist/Technologist | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2007-07-09 |