NPI | 1639130958 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 222Z00000X Orthotist (Licence: MD c19386) |
Additional Taxonomies | 183500000X Pharmacist (Licence: MD 06194) |
Enumeration Date | 2006-03-28 |
Last Update Date | 2012-01-26 |