| NPI | 1144711219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: PA OH000143) |
| Additional Taxonomies | 224L00000X Pedorthist (Licence: PA PD000037) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2018-05-24 |