| NPI | 1386906360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224L00000X (Licence: FL PED207) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: FL C.F.o.00226) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2012-06-14 |