| NPI | 1134417579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225000000X Orthotic Fitter |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2011-07-19 |