| NPI | 1073959045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1744P3200X Specialist, Prosthetics Case Management |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 247000000X Technician, Health Information | |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2013-05-17 |