| NPI | 1255466348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: NC CO003055) |
| Additional Taxonomies | 224L00000X Pedorthist (Licence: CPed0755) |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2022-04-05 |