| NPI | 1154916013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TX 1261) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: TX 1261) |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2021-03-04 |