| NPI | 1689798522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: KY CO004117) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14092) |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2013-04-03 |