| NPI | 1619177334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225000000X Orthotic Fitter (Licence: NC CFO02450) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: NC CFTS1014) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2010-11-02 |