| NPI | 1174890404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TX 1671) |
| Additional Taxonomies | 224L00000X Pedorthist |
| 222Z00000X Orthotist (Licence: TX 1671) | |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2022-07-21 |