| NPI | 1174968630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: DE CP004038) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CA C50285) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2014-05-05 |