| NPI | 1720386477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225000000X Orthotic Fitter (Licence: MD C52107) |
| Additional Taxonomies | 174400000X Specialist (Licence: DE CPed3498) |
| Enumeration Date | 2011-03-04 |
| Last Update Date | 2020-06-10 |