| NPI | 1205972049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: IL 211-000184) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: IL 213-000222) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2010-09-10 |