| NPI | 1205995982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224L00000X Pedorthist (Licence: OH LPED.0069) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: OH LPED.0069) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2014-01-02 |