| NPI | 1932636248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224L00000X Pedorthist (Licence: AR OPP00254) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: AR C52236) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2018-03-17 |