| NPI | 1750822771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225000000X Orthotic Fitter (Licence: KY CFo04010) |
| Additional Taxonomies | 224L00000X Pedorthist (Licence: KY CPed3595) |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2017-03-09 |