| NPI | 1164035952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: NC CPO03960) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NC CPO03960) |
| 222Z00000X Orthotist (Licence: KY 175127) | |
| 224P00000X Prosthetist (Licence: KY 175127) | |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2020-09-11 |