| NPI | 1780858126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225000000X Orthotic Fitter (Licence: NC 7795378) |
| Additional Taxonomies | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: NC 6549) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2008-06-04 |