| NPI | 1891785846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225000000X Orthotic Fitter (Licence: KY C15970) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: IN C15970) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2008-05-23 |