NPI | 1942367131 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225000000X Orthotic Fitter |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: RI AT00194) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 1407) | |
Enumeration Date | 2007-01-03 |
Last Update Date | 2007-07-08 |