| NPI | 1174229868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: FL POR189) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: FL ORT290) |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2023-06-29 |