| NPI | 1124008990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: TX 138) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: TX 138) |
| 225X00000X Occupational Therapist (Licence: TX 102390) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2007-07-08 |