| NPI | 1326299314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: TX CPO02746) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TX LPO1277) |
| 224P00000X Prosthetist (Licence: TX CPO02746) | |
| 224P00000X Prosthetist (Licence: TX LPO1277) | |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2008-10-08 |