| 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 |