NPI | 1942780580 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 224L00000X Pedorthist (Licence: TN PED109) |
Additional Taxonomies | 225000000X Orthotic Fitter (Licence: TN CFO03775) |
Enumeration Date | 2018-08-14 |
Last Update Date | 2018-08-14 |