| NPI | 1265764120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: NC C36329) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NC C36329) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2016-05-04 |