| NPI | 1275726929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management |
| 222Z00000X Orthotist | |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2013-03-06 |