| NPI | 1114209111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225000000X Orthotic Fitter (Licence: NC CFo 03634) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: NC CFts 1242) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2011-09-15 |