| NPI | 1528214848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: CO005479) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IA 001237) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2015-05-11 |