| NPI | 1083116404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: IL 211.000213) |
| Additional Taxonomies | 222Z00000X (Licence: IL 213.000280) |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2018-03-01 |