| NPI | 1558349779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: DE CFo02565) |
| 224L00000X Pedorthist (Licence: DE CPed1198) | |
| 225100000X Physical Therapist (Licence: NY 019369) | |
| 363A00000X Physician Assistant (Licence: NY 008387) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2023-03-07 |