| NPI | 1063663474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: UT C18364) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: UT C18364) |
| 224P00000X Prosthetist (Licence: UT CP003176) | |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2008-11-24 |