| NPI | 1073156261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TN PRO234) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: GA LPO121) |
| 222Z00000X Orthotist (Licence: TN ORT252) | |
| 224P00000X Prosthetist (Licence: GA LPO121) | |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2019-10-21 |