| NPI | 1326698937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist |
| Additional Taxonomies | 222Z00000X Orthotist |
| 224900000X Mastectomy Fitter | |
| 224L00000X Pedorthist | |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2019-09-16 |