| NPI | 1285062125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TX C50469) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: TX C50469) |
| Enumeration Date | 2013-10-30 |
| Last Update Date | 2020-04-09 |