| NPI | 1811320336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: MI CO000992) |
| Additional Taxonomies | 224L00000X Pedorthist (Licence: MI Cped0617) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2013-09-09 |