| NPI | 1275069361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1744P3200X Specialist Prosthetics Case Management (Licence: NV C-34997) |
| Additional Taxonomies | 1744P3200X Specialist Prosthetics Case Management (Licence: NV 1704450989) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2017-05-10 |