| NPI | 1063618791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist |
| Additional Taxonomies | 224P00000X Prosthetist |
| 225000000X Orthotic Fitter | |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2017-10-23 |