| NPI | 1811125156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: KY 13798) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: MD c50155) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2012-10-26 |