| NPI | 1548407299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: OK LO22) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: OK LO22) |
| Enumeration Date | 2009-01-17 |
| Last Update Date | 2009-01-17 |