| NPI | 1821784299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224L00000X Pedorthist (Licence: OH CPED1306) |
| Additional Taxonomies | 222Z00000X (Licence: OH C22312) |
| 222Z00000X (Licence: OH LO.00382) | |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2023-05-11 |