| NPI | 1073613725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: VA CPO02850) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: VA CPO02850) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2008-10-03 |