Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1386043180 |
---|---|
Provider Name | Mr. Soren Lind |
First Address | Aliso Viejo, CA 92656-1461 |
Second Address | Aliso Viejo, CA 92656-1461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2014 |
Last Update Date | 12/06/2017 |