| NPI | 1992772917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OK 26) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: OK 26) |
| 224L00000X Pedorthist (Licence: OK 26) | |
| 225000000X Orthotic Fitter (Licence: OK 26) | |
| 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic | |
| 225700000X Massage Therapist (Licence: OK 157326) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2024-08-28 |