| NPI | 1700311545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: PA OH000015) |
| Additional Taxonomies | 224L00000X Pedorthist (Licence: PA PD000015) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2017-05-01 |