| NPI | 1962570150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225000000X Orthotic Fitter (Licence: NY C16086) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 00256-1) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2008-01-16 |