| NPI | 1073338604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: DE CPOA-0094) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: DE CPOA-0094) |
| 1744P3200X Specialist, Prosthetics Case Management (Licence: DE CPOA-0094) | |
| 222Z00000X Orthotist (Licence: DE CPOA-0094) | |
| Enumeration Date | 2024-11-19 |
| Last Update Date | 2024-11-19 |