NPI | 1154573863 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 222Z00000X Orthotist (Licence: AR OPP00030) |
Additional Taxonomies | 225000000X Orthotic Fitter (Licence: C17466) |
Enumeration Date | 2008-10-14 |
Last Update Date | 2008-10-14 |