| NPI | 1174522668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: TX 77) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: TX 77) |
| 225000000X Orthotic Fitter (Licence: TX 77) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2012-04-23 |