| NPI | 1275073520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1744P3200X Specialist, Prosthetics Case Management (Licence: GA 063690373) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2018-03-20 |