| NPI | 1710022546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: CPO00731) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: CPO00731) |
| 225000000X Orthotic Fitter (Licence: CPO00731) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-08 |