| NPI | 1649425299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225000000X Orthotic Fitter |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IN 27014616A) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2008-11-24 |