| NPI | 1144712423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: PA PO000019) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: PA OH000039) |
| Enumeration Date | 2018-06-03 |
| Last Update Date | 2018-06-03 |