| NPI | 1548603020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: NY BOC C51119) |
| Additional Taxonomies | 224L00000X Pedorthist (Licence: NY CPED 1546) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2013-04-15 |