| NPI | 1265805519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: IL 213.000165) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: IL 211.000141) |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2020-11-03 |