| NPI | 1093878522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225500000X Specialist/Technologist |
| Additional Taxonomies | 222Z00000X |
| 224P00000X Prosthetist | |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2025-09-11 |