| NPI | 1104997907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: SC 042374420) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: SC 042374420) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-09 |