| NPI | 1255318176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: IL 213000216) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: IL 211000198) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2007-07-09 |