| NPI | 1730615931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: PA OH000057) |
| Additional Taxonomies | 224L00000X Pedorthist (Licence: PA PD000010) |
| Enumeration Date | 2017-05-08 |
| Last Update Date | 2017-05-08 |