NPI | 1205311594 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 222Z00000X Orthotist (Licence: MI C52545) |
Additional Taxonomies | 224P00000X Prosthetist (Licence: MI C52545) |
Enumeration Date | 2018-10-02 |
Last Update Date | 2019-06-10 |