| NPI | 1326015744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: TX 591) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NM CO004444) |
| 222Z00000X Orthotist (Licence: NM C10795) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2014-12-29 |