| NPI | 1063472041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: FL POR150) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT11703) |
| 222Z00000X Orthotist (Licence: FL POR150) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2019-10-11 |