| NPI | 1548398191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: NY CO1917) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NJ 45PO00005100) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2007-12-12 |