| NPI | 1245749969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CPO04189) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CO005798) |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2018-10-23 |