| NPI | 1194981282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1744P3200X Specialist, Prosthetics Case Management (Licence: GA 46) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: GA 000046) |
| 222Z00000X Orthotist (Licence: GA 000046) | |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2009-10-15 |