| NPI | 1841649167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: TX CO005620) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CO005620) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2019-10-22 |