| NPI | 1770701526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1700X Technician/Technologist, Ocularist (Licence: NC 27-3468101) |
| Additional Taxonomies | 225000000X Orthotic Fitter |
| 1744P3200X Specialist, Prosthetics Case Management (Licence: NC 27-3468101) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2013-07-18 |