| NPI | 1659404705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: CO001583) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 1583) |
| 174400000X Specialist (Licence: CO001583) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2012-08-01 |