NPI | 1134246895 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 224L00000X Pedorthist (Licence: IA 074625) |
Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist |
Enumeration Date | 2007-03-26 |
Last Update Date | 2015-10-06 |