| NPI | 1154405546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AL 1499) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: AL 1499) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-07-09 |