| NPI | 1235679366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: MD CPO02454) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: MD CPO02454) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2017-03-08 |