| NPI | 1568457760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: AL 128) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH1624) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2007-07-09 |