| NPI | 1174696736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: NY 1127940) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: NY 1127940) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2008-02-01 |