| NPI | 1295999399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist |
| Additional Taxonomies | 174400000X Specialist |
| 224Z00000X Occupational Therapy Assistant (Licence: NY 004659) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2009-10-13 |