| NPI | 1215277728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TN PRO0000000058) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TN ORT0000000069) |
| Enumeration Date | 2013-02-20 |
| Last Update Date | 2013-02-20 |