| NPI | 1285175109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: IL 213.000297) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: IL 211.000412) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2024-10-16 |