| NPI | 1821145400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225000000X Orthotic Fitter (Licence: CFts0684) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: CFo02049) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2013-02-12 |