| NPI | 1154432961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 225000000X Orthotic Fitter | |
| 261QV0200X Clinic/Center, VA | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-01-11 |