| NPI | 1902246382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: VA CO003610) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TN ORT0000000131) |
| 222Z00000X Orthotist (Licence: MD C12193) | |
| 222Z00000X Orthotist (Licence: CA CCS) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2020-01-16 |