| NPI | 1134318603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225000000X Orthotic Fitter (Licence: IL 213000043) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: IL 211000029) |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2007-10-19 |