| NPI | 1134994304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: KY 282012) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: KY 282012) |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2023-11-17 |