| NPI | 1942209838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: CPO02860) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: CPO02860) |
| 225100000X Physical Therapist (Licence: NY 025470-1) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2011-08-12 |