| NPI | 1639302037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: OK 28) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TX 180) |
| 225000000X Orthotic Fitter (Licence: TX 1148) | |
| 225000000X Orthotic Fitter (Licence: OK 9) | |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2009-09-01 |