| NPI | 1356335343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: NJ PO 00001900) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: NJ PO 00001900) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2008-07-14 |