| NPI | 1083376982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: 211000091) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: 213000080) |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2021-10-07 |