NPI | 1376877548 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 222Z00000X Orthotist (Licence: NJ 45OR00005200) |
Additional Taxonomies | 222Z00000X Orthotist (Licence: NJ CO4627) |
Enumeration Date | 2009-09-22 |
Last Update Date | 2022-10-24 |