| NPI | 1043526700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: CPO02491) |
| Additional Taxonomies | 222Z00000X Orthotist |
| 224P00000X Prosthetist (Licence: CPO02491) | |
| 224P00000X Prosthetist | |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2022-04-05 |